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EDITORIAL: House GOP budget-cutters vainly in search of Medicaid mammoth

Advocate, The (Baton Rouge, LA)

Dec. 20--After much huffing and puffing to little purpose, the House GOP folded its poor hand in a showdown in the State Capitol over managed-care contracts for Medicaid.

It was a clear win for Gov. John Bel Edwards, as the debate over several months in the joint budget committee showed that the House GOP picked the wrong battle. It also underlined differences between the Republicans in the Senate and in the House.

The contracts extended terms of the five managed-care companies overseeing services for 90 percent of Louisiana's Medicaid patients, or about 1.5 million people. The GOP members, led by Appropriations Committee Chairman Cameron Henry of Metairie, wanted to use the complex management contracts to cut Medicaid spending; they ignored staff who lectured them, politely but again and again, that the scope of services is not what the managed-care contracts were about.

The Joint Legislative Committee on the Budget held three hearings on the extensions. At the first hearing, no vote was taken because lawmakers wanted more questions answered. At the second, senators on the committee voted unanimously for the deals, and most House GOP lawmakers voted against them. At the third hearing, all but two House Republicans refused to support the deals, while senators didn't vote after House members blocked passage.

It takes majority votes of both Senate and House members to pass items through the joint committee. Finally, in December, the contracts were let through, a win for Edwards. The best Henry and Co. could claim to achieve were vague assurances that the Legislative Auditor's Office would have more authority to review Medicaid billings. Not much, that, as the auditor's office already has sweeping authority.

This debate showed House and Senate Republicans are clearly not on the same page, not that many observers in the State Capitol were in doubt about that.

The House GOP wants to cut Medicaid to avoid wrenching votes on tax increases that are politically difficult. But ask about specific cuts and members get vague, or indignant that they would want to take, say, hospice care from a working-class cancer patient.

There's not much "there" there. Challenging the management contracts created a needless controversy that gives a false appearance of economizing. Debating process was a substitute for courageous cuts.

The House GOP's budget-cutters are a band of pygmies stumbling across the legislative veldt in pursuit of the giant woolly mammoth of Medicaid spending -- mostly federal funds, but at $12 billion, about half the state budget.

They seek a spare billion or so that they can cut from the mammoth carcass. Perhaps the poor will suffer; if one is a pygmy legislator from a better-off suburb, that matters little politically. But Medicaid's billions are paid to doctors and hospitals. We can acquit the Legislature en masse from concern for the poor, but they are devoted to the powerful interest groups hurt if the pygmies get their toothpicks into the woolly mammoth.

Many Republicans represent rural areas where hospitals are one of the major employers. They will not look kindly on a mammoth roast that forces their local hospital into bankruptcy. Just look at Washington, D.C., where GOP plans to cut health insurance turned out to be unpopular.

If they are dead unlucky, the pygmies will catch the woolly mammoth. And its death throes might squash some of them, perhaps many of them.